Low Retention Rates Research Articles

Can compassionate leadership of senior hospital leaders help retain trainee doctors?

BackgroundHigh burnout and low retention rates among trainee doctors threaten the future viability of the UK medical workforce. This study empirically examined factors that can sustain trainee doctors.MethodA total of...

Recruitment and Retention Issues in a Technology-Based Intervention Among Korean American Midlife Women With Depressive Symptoms.

The number of health technology-based intervention studies has grown significantly. However, issues in the recruitment and retention for such studies, especially of Asian Americans, have rarely been discussed. The purpose of this paper was to discuss issues in the recruitment and retention of a specific group of Asian Americans-Korean American midlife women with depressive symptoms-into a technology-based intervention study using computers and mobile devices with a measurement device and to provide directions for future participant recruitment and retention in technology-based intervention studies. The written memos of research team members and the written records of research team meetings were analyzed using a content analysis. The issues in the recruitment and retention process included (1) low recruitment and retention rates; (2) the perceived long intervention period; (3) strict inclusion/exclusion criteria; (4) concerns related to the use of a measurement device; and (5) the perceived adequacy of monetary incentives. Based on the issues identified in the study, several suggestions are made for future recruitment and retention of racial/ethnic minorities in technology-based intervention studies (eg, appropriate intervention period, innovative and creative motivation strategies, acceptable measurement scales and devices, and adequate monetary reimbursement).

Efficacy and safety of add-on antiseizure medications for focal epilepsy: A network meta-analysis.

Several antiseizure medications (ASMs) have been approved for the treatment of focal epilepsy. However, there is a paucity of evidence on direct comparison of ASMs. We evaluated the comparative efficacy and safety of all approved add-on ASMs for the treatment of focal epilepsy using network meta-analysis. Data through extensive literature search was retrieved from PubMed, Embase, Cochrane, and ClinicalTrial.gov databases using predefined search terms from inception through March 2023. PRISMA reporting guidelines (CRD42023403450) were followed in this study. Efficacy outcomes assessed were ≥50%, ≥75%, and 100% responder rates. Patient retention rate and safety outcomes such as overall treatment-emergent adverse events (TEAEs) and individual TEAEs were assessed. "Gemtc" 4.0.4 package was used to perform Bayesian analysis. Outcomes are reported as relative risks (RRs) and 95% confidence interval (CI). Literature search retrieved 5807 studies of which, 75 studies were included in the analysis. All ASMs showed significantly higher ≥50% responder rate compared with placebo. Except the ≥75% seizure frequency reduction for zonisamide (2.23; 95% CI: 1.00-5.70) and 100% for rufinamide (2.03; 95% CI: 0.54-11.00), all other interventions showed significantly higher ≥75% and 100% responder rates compared with placebo. Among treatments, significantly higher 100% responder rate was observed with cenobamate compared to eslicarbazepine (10.71; 95% CI: 1.56-323.9) and zonisamide (10.63; 95% CI: 1.37-261.2). All ASMs showed a lower patient retention rate compared to placebo, with the least significant value observed for oxcarbazepine (0.77; 95% CI: 0.7-0.84). Levetiracetam showed a lower risk of incidence (1.0; 95%CI: 0.94-1.1; SUCRA: 0.885067) for overall TEAE compared with other medications. All approved ASMs were effective as add-on treatment for focal epilepsy. Of the ASMs included, cenobamate had the greatest likelihood of allowing patients to attain seizure freedom. This article compares the efficacy and safety of antiseizure medications (ASMs) currently available to neurologists in the treatment of epileptic patients. Several newer generation ASMs that have been developed may be as effective or better than the older medications. We included 75 studies in the analysis. In comparison, all drugs improved ≥50%, ≥75% and 100% responder rates compared to control, except for Zonisamide and Rufinamide in the ≥75% and 100% responder rate categories. Retention of patients undergoing treatment was lower in drugs than placebo. All drugs were tolerated, the levetiracetam showed the best tolerability. Cenobamate more likely help completely to reduce seizures.

Assessment of treatment retention rates and predictors of retention on opioid agonist treatment among adolescents.

Opioid agonist treatment (OAT) is an effective treatment for opioid dependence syndrome in adults. However, studies on effectiveness of OAT in adolescents are limited; existing studies show varying retention rates. The present study aimed to assess OAT retention rates in adolescent patients with opioid dependence syndrome registered in a community drug treatment clinic in Delhi, India, and to analyse factors associated with retention at 1 year. Retrospective cohort study. All adolescents (n = 130) aged 10-19 years, started on OAT from January 2020 to July 2022 were included. Baseline and follow-up data was extracted from online record system maintained at the clinic. OAT retention rates at different timepoints were assessed. Multivariable logistic regression was used to discern factors associated with one-year retention. The participants' mean age was 16.9 (SD 1.4) years. Mean age of starting opioids was 14.9 (SD 2.2) years; 29.5% (n = 38) injected opioids. The 6-, 12-, 18- and 24-month retention rate on OAT was 64.4%, 45.6%, 38.7% and 29% respectively. The retention rates with buprenorphine and methadone were comparable. Multivariate logistic regression showed retention for less than 12 months to be significantly associated with younger age of starting heroin, involvement in illegal activities, absenteeism from school and substance use in family. The 12-month retention rates on OAT in adolescents is comparable to retention rates in adults. Various factors associated with early age of onset of opioid use are also associated with lower retention rates on OAT.

The Relationship Between College Interventions and First-Generation College Students’ Academic Success at a Large Urban Tier I Institution

ABSTRACT Success in higher education has been a challenge for many first-generation college students (FGCS). Unfortunately, higher education institutions have adopted the “one-size-fits-all” approach to addressing low retention and graduation rates. This approach is alarming because it does not address the specific constraints of academic success for FGCS. This study investigated how college interventions programs impact the academic success of first-generation college students. The results show that FGCS who participated in a first-year seminar or lived in on-campus student housing had higher GPAs than FGCS who lived off-campus. Overall, these findings highlight the influence of high-impact interventions on FGCS’ academic success.

Health system facilitators and barriers to the integration of mental health services into primary care in the Democratic Republic of the Congo: a multimethod study

BackgroundThe integration of mental health into primary care—i.e., the process by which a range of essential mental health care and services are made available in existing multipurpose health care settings that did not previously provide them—can be facilitated or hindered by several health system factors that are still poorly understood. This study aimed to identify health system facilitators and barriers to the integration of mental health services into primary care in the Democratic Republic of the Congo (DRC) to improve the success rate of integration programs.MethodsWe conducted a multimethod, cross-sectional exploratory study. Stakeholders (managers, health service providers, service users, etc.) from sixteen of the twenty-six provinces of the DRC participated. We collected qualitative data through 31 individual, semistructured, face-to-face key informant interviews. We then collected quantitative data through a population-based survey of 413 respondents. We analyzed the interviews via thematic analysis, assigning verbatims to predefined themes and subthemes. For the survey responses, we performed descriptive analysis followed by binomial logistic regression to explore the associations between the variables of interest.ResultsStrong leadership commitment, positive attitudes toward mental health care, the availability of care protocols, mental health task sharing (p < 0.001), and sufficient numbers of primary care providers (PCPs) (p < 0.001) were identified as key health system facilitators of successful integration. However, barriers to integration are mainly related to a poor understanding of what integration is and what it is not, as well as to the poor functionality and performance of health facilities. In addition, stigma, low prioritization of mental health, lack of mental health referents, low retention rate of trained health professionals, lack of reporting tools, lack of standardized national guidelines for integration (p < 0.001), lack of funding (p < 0.001), shortage of mental health specialists to coach PCPs (p < 0.001), and lack of psychotropic medications (p < 0.001) were identified as health system barriers to integration.ConclusionImproving the functionality of primary care settings before integrating mental health care would be beneficial for greater success. In addition, addressing identified barriers, such as lack of funding and mental health-related stigma, requires multistakeholder action across all building blocks of the health system.

Lignin Purification from Mild Alkaline Sugarcane Extract via Membrane Filtration

In this study, the separation of lignin from a mild alkaline sugarcane bagasse extract was studied, and the impacts of different parameters on the filtration performance were evaluated. The tested parameters included transmembrane pressure (0.5–3.0 bar), shear rates (2831–22,696 s−1), temperature (20 and 40 °C), membrane molecular weight cut-off (5 and 10 kDa), and membrane material (polyethersulfone and polysulfone). During the filtration process, the permeate flux and all the main components of the extract were analyzed, including lignins (acid insoluble lignin and acid soluble lignin), sugars (xylose, arabinose, glucose, and galactose), total phenolic compounds, and phenolic acids (p-coumaric acid, ferulic acid, vanillin, and 4-hydroxybenzaldehyde). It was proved that the tested conditions had a great impact on the permeate flux and molecule retention rate. Increasing the temperature from 20 to 40 °C resulted in a much higher permeate flux for the 5 kDa PES membrane, and the impact of shear rate was greater at 40 °C for this membrane. Although the 5 kDa PES membrane could retain slightly more large molecules, i.e., acid-insoluble lignin and xylose, the 10 kDa membrane afforded greater phenolic acid removal capacity, leading to higher purity. For the 10 kDa PS membrane, the polarization layer began to form at TMP below 0.5 bar. This membrane had a lower retention rate for all molecules than the 10 kDa PES membrane.

A bibliometric analysis on gamifying adult learning: past, present and future trends of learner-centered pedagogies

Purpose The psychological theory of self-determination postulated that gamification enhances learning engagement by intrinsically motivating learners to undertake tasks spontaneously. Gamification has then been integrated into adult learning as part of the initiative of learner-centred pedagogies to curb the low retention rates of adult learners who struggle with heavy work commitments, family obligations and financial pressure. Gamification, being one of the technological mediations, assumes the crucial role of engaging and retaining adult learners. Adult learners have received less attention in research when compared with conventional university students. The purpose of this study is to conduct a bibliographic analysis to assess the past, present and future publication trends of gamifying adult learning and to identify the research gap. Design/methodology/approach This study included publications related to gamification and adult learning from 2014 to 2022, extracted from Dimensions. A total of 79,864 publications were retrieved initially, and 3,469 publications were ultimately selected for final analysis after the refinement of the keyword search. VOSviewer was used for bibliographic coupling, keyword co-occurrence, clustering and co-citation analysis of countries. Findings The number of publications related to gamification in adult learning has decreased since its peak in 2020. The saturation is mainly concentrated in the USA, the UK and China, with similar levels of national income and technology advancement skills. However, gamification in adult learning remains a popular and growing research area in developing countries like Malaysia, which has huge potential due to government investments in education, technology and lifelong learning. There is also an evident research gap on gamification, adult learning and personality traits, which have not been covered in previous studies. Originality/value Prior research mostly focused on systematic literature reviews, while the use of bibliometric analysis could be a missing link in this research domain. This paper unveils the evolution of publications on this topic over time by scientifically analysing a large number of publications and rigorously identifying research gaps contributing to future research avenues.

Unicorn paradox: Understanding undergraduate Black men's leader identity, capacity, and efficacy.

This study highlights opportunities for developing programs and initiatives to assist Black men in understanding leadership and seeing themselves as leaders, and for decreasing low college retention and persistence rates. The themes from this qualitative narrative inquiry highlight leader identity, capacity, and efficacy for undergraduate Black men. Narrative inquiry was appropriate for this study because the researchers sought to better understand how Black undergraduate male student leaders make meaning of their experience in higher education related to their comprehension of leadership and identity as leaders.

The impact of social media intervention based on functional motivation on repeat blood donation behavior: A prospective randomized controlled trial study.

Blood plays an irreplaceable role in medical care. Low retention rate among blood donors is the major issue in China. Various functional motivations can encourage blood donors to participate in blood donation. Therefore, it is necessary to conduct research studies on re-donate behavior based on functional motivations. This study aimed to evaluate the impact of social media intervention based on functional motivation, to discover effective intervention methods to improve re-donate rate among nonregular blood donors. In 2022-2023, 726 adults aged 18-55 years were randomized into the intervention or control group. Over 6 months, the intervention group received science popularization via social media. After the follow-up period, re-donate rate and functional motivation were assessed. Statistical analyses included t-test, chi-square test, logistic regression analysis, and analysis of variance. Five hundred and sixty-eight participants completed the intervention survey. Overall, the repeat blood donation rate in the intervention group (18.1%) was significantly higher than the control group (4.2%) (p < .001). After the intervention, understanding, protection, sensation, and values motivation increased (p < .001). The changes in functional motivations vary across different age groups. In the 18-30 age group, understanding motivation increased (p < .001), while in the 31-45 and 46-55 age groups, protection motivation increased (p < .001). In the groups donating blood 3 time and 4 time, protection motivation increased (p < .05), and in the group donating blood 4 times, the values motivation increased (p < .05). Social media intervention based on functional motivation can effectively increase the re-donate rate. Understanding, protection, sensation, and values motivations can directly influence the re-donate behavior.

Experimental study on the retention of aerosol particles through concrete cracks under high Reynolds number flow

In the event of severe accidents in pressurized water reactor (PWR) nuclear power plants, the potential leakage of radioactive aerosols through containment cracks poses a considerable radioactive hazard to the public. Understanding aerosol transport and retention in cracks helps reduce the conservatism and uncertainty of radioactive hazard assessment. Concrete cracks are recognized as a pivotal pathway for the leakage of radioactive aerosols, and several researchers have undertaken experimental investigations concerning the aerosol transport and retention in concrete cracks. However, the majority of these studies have rather low gas flow Reynolds numbers. In this work, an experimental setup is built to study aerosol transport and retention in concrete cracks under high Reynolds number flow. The TiO2 aerosol with a mass median diameter of 1 μm and two concrete crack specimens are used in experiments. The results of gas flow experiments indicate that the Reynolds number is capable of reaching 10547. Combining the flow experimental data and Suzuki's formula, the equivalent heights of these two crack specimens are approximated as 303.67 μm and 231.48 μm. The experimental results indicate a notably high retention rate of aerosols, exceeding 0.8. Furthermore, under high Reynolds number flow, the retention rate varies over a relatively narrow range, with the larger the equivalent height of the crack resulting in a lower retention rate. The experimental results match well with the mechanistic analysis based on inertial deposition theory, demonstrating the rationality of the inertial deposition theory.

A New Paradigm in Spinal Cord Injury Therapy: from Cell-free Treatment to Engineering Modifications.

Spinal cord injury (SCI) is an intractable and poorly prognostic neurological disease, and current treatments are still unable to cure it completely and avoid sequelae. Extracellular vesicles (EVs), as important carriers of intercellular communication and pharmacological effects, are considered to be the most promising candidates for SCI therapy because of their low toxicity and immunogenicity, their ability to encapsulate endogenous bioactive molecules (e.g., proteins, lipids, and nucleic acids), and their ability to cross the blood-brain/cerebrospinal barriers. However, poor targeting, low retention rate, and limited therapeutic efficacy of natural EVs have bottlenecked EVs-based SCI therapy. A new paradigm for SCI treatment will be provided by engineering modified EVs. Furthermore, our limited understanding of the role of EVs in SCI pathology hinders the rational design of novel EVbased therapeutic approaches. In this study, we review the pathophysiology after SCI, especially the multicellular EVs-mediated crosstalk; briefly describe the shift from cellular to cell-free therapies for SCI treatment; discuss and analyze the issues related to the route and dose of EVs administration; summarize and present the common strategies for EVs drug loading in the treatment of SCI and point out the shortcomings of these drug loading methods; finally, we analyze and highlight the feasibility and advantages of bio-scaffold-encapsulated EVs for SCI treatment, providing scalable insights into cell-free therapy for SCI.

Where are services regarding sexual minorities and psychological therapies post-COVID in 2024? A mixed-method systematised review

Purpose Since COVID-19, many services have burgeoned within the UK, but what about sexual minorities? Since the last review, there are appropriate therapies, but there is often inadequate research. The purpose of this mixed-method review synthesis looking into the efficacy of psychological therapies for sexual minorities. Seven studies were found in total. Design/methodology/approach A mixed-method review synthesis, three studies looking into the efficacy of psychological therapies for sexual minorities and four studies addressing the experiences of sexual minorities partaking in psychological therapies were identified. Findings These included three quantitative and four qualitative studies. The minority stress hypothesis is used to formulate problems, but challenges remain to confidentiality and privacy in this context. Therapists still operate within the heteronormative framework, discounting intersectionality in therapy conversations. Research limitations/implications Most studies have had low retention rates since 2021. It shows that minority stress needs to be accounted for at the ethics committee and research delivery levels. Practical implications Applying a heteronormative framework to sexual minorities is not working. An alternative progress world view is needed. Social implications Health-care clinicians strive for equitable care. Unfortunately, using an equitable health service scale adapted from Levesque et al. (2013), the rating is 3 out of 6. More work is needed to improve services. Originality/value Some services are reporting much improvement post-pandemic. Sadly, this is not the case for sexual minorities. Individual and systemic barriers remain.

Preliminary Study about Desalinated Water and Alkalinity

One of the promising techniques to meet the needs of growing population for drinking water is the desalination of seawater and brackish water. Desalination is carried out mainly by multi-stage flash (MSF) or reverse osmosis (RO). The water obtained by desalination (RO, MSF and others processes) can be used as drinking water, after the reconstruction of its salts content (blending). However, reverse osmosis can produce, under certain pressure, flow and feed water quality, water similar in their physic-chemical properties as conductivity, Total Dissolved Salts (TDS) to bottled natural water, widely marketed. In any case, it would be interesting to be able to distinguish reverse osmosis water from sprig water. In this context, the determination of the alkalinity (TA) and the pH and subsequently the verification of the correlation between these two parameters are proposed in this work. Also, a comparison of the physic-chemical quality of drinking water supplied by MSF and RO is made. The parameters, pH, conductivity, TA, TDS and hardness (TH) were discussed. These two types of water are practically identical by physic-chemical quality since the blending is done in the same way by injecting CO2/Calcium carbonate. However, reverse osmosis water contains more sodium chloride because of the low retention rate of membranes against this ion.

Trends and determinants of clinical staff retention in the English NHS: a double retrospective cohort study

ObjectivesTo investigate how demographic, contractual and organisational factors are related to the retention of hospital workers in the English NHS. The study will specifically examine the trends in age-retention profiles.DesignA...

The good lecture

Postgraduate medical education often relies on the traditional lecture model with low knowledge retention rates of 5-20%. Cognitive overload from excessive information during lectures diminishes learning efficacy. To optimise learning, evidence suggests prioritising active engagement, streamlining visual aids, introducing clinical scenarios, and incorporating audience response systems may further enhance retention and comprehension. In conclusion, the traditional lecture must evolve into more interactive and engaging modalities to facilitate increased participant long-term learning as summarised in this review.

An Examination of Diversity, Equity, Inclusion, and Belonging (DEIB) Initiatives in Large U.S. Public Accounting Firms to Recruit and Retain Women and Minorities in the Workplace

Public accounting firms are currently facing lower recruitment and retention rates, but the use of effective and authentic diversity, equity, inclusion, and belonging initiatives can better the workplace environment. Through different DEIB initiatives, like mentorship programs, anti-bias training, employee resource groups, inclusive leadership, and pay equity, women and minorities can feel represented and comfortable in the workplace. From analyzing Big Four DEI Transparency Reports, a relationship is shown between effective DEIB initiatives and recruitment and retention within the firms. Furthermore, these DEIB initiatives are important aspects of a firm’s business strategy to be able to compete with one another.

Mechanically reinforced hydrogel vehicle delivering angiogenic factor for beta cell therapy

Type 1 diabetes mellitus (T1DM) is a chronic disease affecting millions worldwide. Insulin therapy is currently the golden standard for treating T1DM; however, it does not restore the normal glycaemic balance entirely, which increases the risk of secondary complications. Beta-cell therapy may be a possible way of curing T1DM and has already shown promising results in the clinic. However, low retention rates, poor cell survival, and limited therapeutic potential are ongoing challenges, thus increasing the need for better cell encapsulation devices. This study aimed to develop a mechanically reinforced vascular endothelial growth factor (VEGF)-delivering encapsulation device suitable for beta cell encapsulation and transplantation. Poly(l-lactide-co-ε-caprolactone) (PLCL)/gelatin methacryloyl (GelMA)/alginate coaxial nanofibres were produced using electrospinning and embedded in an alginate hydrogel. The encapsulation device was physically and biologically characterised and was found to be suitable for INS-1E beta cell encapsulation, vascularization, and transplantation in terms of its biocompatibility, porosity, swelling ratio and mechanical properties. Lastly, VEGF was incorporated into the hydrogel and the release kinetics and functional studies revealed a sustained release of bioactive VEGF for at least 14 days, making the modified alginate system a promising candidate for improving the beta cell survival after transplantation.

Managing Opioid Withdrawal Symptoms During the Fentanyl Crisis: A Review.

Illicitly manufactured fentanyl (IMF) is a significant contributor to the increasing rates of overdose-related deaths. Its high potency and lipophilicity can complicate opioid withdrawal syndromes (OWS) and the subsequent management of opioid use disorder (OUD). This scoping review aimed to collate the current OWS management of study populations seeking treatment for OWS and/or OUD directly from an unregulated opioid supply, such as IMF. Therefore, the focus was on therapeutic interventions published between January 2010 and November 2023, overlapping with the period of increasing IMF exposure. A health science librarian conducted a systematic search on November 13, 2023. A total of 426 studies were screened, and 173 studies were reviewed at the full-text level. Forty-nine studies met the inclusion criteria. Buprenorphine and naltrexone were included in most studies with the goal of transitioning to a long-acting injectable version. Various augmenting agents were tested (buspirone, memantine, suvorexant, gabapentin, and pregabalin); however, the liberal use of adjunctive medication and shortened timelines to initiation had the most consistently positive results. Outside of FDA-approved medications for OUD, lofexidine, gabapentin, and suvorexant have limited evidence for augmenting opioid agonist initiation. Trials often have low retention rates, particularly when opioid agonist washout is required. Neurostimulation strategies were promising; however, they were developed and studied early. Precipitated withdrawal is a concern; however, the rates were low and adequately mitigated or managed with low- or high-dose buprenorphine induction. Maintenance treatment continues to be superior to detoxification without continued management. Shorter induction protocols allow patients to initiate evidence-based treatment more quickly, reducing the use of illicit or non-prescribed substances.

FCGR3A-V158F gene polymorphism: A potential predictor for rituximab dosing optimization in Chinese patients with neuromyelitis optica spectrum disorder

BackgroundRituximab (RTX), an anti-CD20 monoclonal antibody, has shown promise in managing neuromyelitis optica spectrum disorders (NMOSD) by depleting B cells and reducing relapses. However, there is no consensus on the optimal RTX dosing regimen, and genetic factors, such as FCGR3A-V158F polymorphism, may influence treatment outcomes. This study investigates how FCGR3A-V158F genotypes influence RTX efficacy in Chinese NMOSD patients under varying dosing regimens and aims to optimize treatment protocols. MethodsWe conducted a retrospective analysis of 25 Chinese NMOSD patients treated with RTX, grouped into standardized and low-dosage regimens. FCGR3A-V158F genotypes were determined, and treatment responses were evaluated, including relapse rates, time to first relapse (TFR), B-cell depletion, dose adjustments, and treatment retention. ResultsAmong all patients, 15 received standardized dosages, while 10 received varied induction doses (500 mg to 1200 mg) in low-dose regimens. For FCGR3A-V158F genotypes, 15 had the FF genotype, and 10 were V carriers (3 VV genotype, 7 VF genotype). Regardless of dosing, FF genotype patients had a higher relapse rate post-RTX treatment compared to V carriers (P < 0.05). None of the 3 VV genotype patients in either dose group experienced relapses post-RTX. In both dose groups, FF genotype patients had significantly shorter TFR and required more RTX dose adjustments post-RTX treatment compared to V carriers in the standardized dosage group (P < 0.05). FF genotype patients in the low dosage group were more likely to experience insufficient B-cell depletion, had lower treatment retention rates, and more discontinuations than V carriers in the standardized dosage group (P < 0.05). Insufficient B-cell depletion significantly predicted clinical relapses after RTX treatment (P < 0.05). In survival analysis, FF genotype patients, regardless of dosing, experienced earlier relapses post-RTX treatment (P < 0.05). ConclusionsThis study highlights the importance of RTX dosage selection in NMOSD treatment, particularly for FCGR3A-FF genotype patients. Standard-dose RTX therapy with vigilant monitoring of peripheral blood B-cell levels is recommended for these individuals to optimize treatment efficacy.